Originally published in The Seattle TImes, (March 16, 2004)

Sara Cook, a stylish brunette with a Snow White complexion, lies face down as hair-thin needles are gently slipped into her ankles, the backs of her knees, her lower back and ears.

A dull, warming sensation creeps over her as the small examination room with its sweet menthol smell fades away, as do worries about ovulation schedules, hormone shots and what’s next after four failed attempts at in-vitro fertilization.
Since October, Cook, 34, has been needled once a week by downtown Seattle acupuncturist Stephanie Gianarelli in hopes of improving her chances of getting pregnant.
Used for 2,500 years in traditional Chinese medicine and best known in Western circles as a New Age pain zapper, acupuncture has gained a following among Seattle-area women — and couples — as an infertility therapy.

Some, like Cook, have left no stone unturned, combining the ancient remedy with the best that modern medicine has to offer, including fertility drugs and test-tube technology. Others eschew the expensive and emotionally draining tactics of fertility clinics and place their hopes on the head of a pin.

“Western medicine uses the sledgehammer approach to infertility,” says Gianarelli, who specializes in the problem. “But acupuncture coaxes the entire body into balance and better health so it’s ready to conceive.”

Even mainstream physicians are hard-pressed to completely dismiss acupuncture, at least when used in conjunction with their high-tech methods. In fact, many of the women who slip away from their downtown offices for half-hour sessions with Gianarelli each week were referred by their infertility doctors.

That’s because two years ago a German study found acupuncture boosts the success rate of in-vitro fertilization (IVF), where egg and sperm meet in a laboratory dish and resulting embryos are transplanted to the womb. The study of 160 IVF patients found that women who had acupuncture right before and after the embryo transfer increased their chances of pregnancy from 26 percent to 43 percent.

“It’s only one study,” Dr. Lori Marshall, an infertility doctor at Virginia Mason Medical Center, cautions her patients. “But it’s enough to say, ‘Hey, there could be something there.’ ”

It’s also enough to persuade 20 to 30 percent of her clinic’s IVF patients to go under the needle. Other IVF clinics in the Seattle area report similar numbers of patients using acupuncture.

Because acupuncture isn’t likely to do any harm and, at about $60 to $100 a visit, is relatively inexpensive compared with mainstream fertility help, many women are willing to take their chances. Plus, because of a state law, insurers must pay for acupuncture treatment for problems that they cover.

“It used to be people just came as a last resort, after they’ve failed everything else. Now we’re more often seeing women trying this before they go down those other roads,” says Greg Bantick, academic dean at Seattle Institute of Oriental Medicine.

With more patients asking if they should get needled, Dr. LaTasha Craig at the University of Washington Fertility and Endocrine Center wants to be able to provide a more definitive answer. So she’s about to put the German findings to the test. Starting this summer, she plans to enroll 200 women in a trial comparing IVF plus acupuncture to IVF alone. She anticipates her biggest challenge will be recruiting enough women to agree they won’t get acupuncture.

Willing to try anything

After eight years of trying to get pregnant and three failed rounds of IVF, lingerie merchandiser Sara Cook and her husband, Jason, a firefighter, were willing to try anything. “I wanted to know I did everything I possibly could to make this work,” she says.

Although their insurance covers most of the costs of IVF, they’ve spent about $15,000 out of pocket. In October, to prepare for her fourth and final attempt at an embryo transfer, Cook began seeing Gianarelli once a week, with the blessing of her physician.
“These patients are going down a pretty rough road. Anything that makes them feel better, I’m for,” says Dr. Lee Hickok, her IVF doctor at Swedish Medical Center.

Although the embryos implanted in January didn’t result in pregnancy, Cook hasn’t given up on acupuncture. She’s considering having a surrogate carry her embryo, so she and her husband come in for weekly acupuncture sessions aimed at fortifying her eggs and his sperm.

Acupuncture can do more than bolster IVF’s success rate, says acupuncturist Kerong Xie, who works out of a converted house in Seattle’s University District. Along with Chinese herbs, it can cure most cases of infertility, she says matter-of-factly.

Needless to say, this is where acupuncturists and mainstream doctors part company.
Rifling through a stack of Christmas-card photos and birth announcements from grateful patients, Xie tallies her recent successes. She estimates about 17 or 18 pregnancies since October.

In traditional Chinese medicine, conditions such as infertility are fundamentally seen as blockages or imbalances in the body’s “qi” (pronounced chee), a vital force or energy that flows throughout the body along channels called meridians.

Xie diagnoses a patient by examining her tongue, asking a list of personal questions and taking several pulses. She then strategically sticks needles so tiny they hardly can be felt into points of the body that she says act as valves to manipulate qi, disperse it when it’s blocked, stimulate it when it’s stagnating and, in general, get the body’s qi humming along.

Treating infertility is a standard part of acupuncture training, says Steve Given, who heads the acupuncture clinic at Bastyr Center for Natural Health in Seattle. “Oriental medicine excels at identifying individual patterns of disharmony. If you lined up 100 different women with infertility, an acupuncturist could have a slightly different treatment for each of them.”

What’s seen in Western medicine as a blocked fallopian tube is blocked or stagnating qi to Xie.

“I prepare the body for pregnancy — how do you plant seeds when the dirt is very thin?” she asks.

Many doctors don’t know what to make of such mystical adages.

“There’s just no Western medical equivalent to this stuff,” Hickok says. He’ll grant that acupuncture may promote relaxation and reduce stress levels. At best, he could see this slightly improving a woman’s chances of conceiving and, at the least, it can help patients feel better and more in control. Other doctors speculate acupuncture could increase blood flow to the uterus or boost production of endorphins, the body’s feel-good chemicals that impact certain hormones.

There’s no scientific evidence that needling alone improves pregnancy rates, so most doctors discourage women who are having trouble getting pregnant from relying solely on acupuncture.

“I would hate to see women who are 35 and up get hung up in alternative therapy that may not be all they need,” says Dr. Kevin Johnson, an infertility doctor at Overlake Hospital Medical Center in Bellevue. He worries that women who could be helped with more-aggressive therapies could be squandering their final fertile years.

He urges a fertility checkup before pursuing acupuncture. “A totally blocked fallopian tube won’t be helped by acupuncture, nor will bad eggs,” he says. And no amount of tinkering with a woman’s qi is going to help if the problem is actually her partner’s low sperm count.

The other sticking point for Western doctors is the cornucopia of herbs that acupuncturists often prescribe to be boiled up in a pungent tea.

“That’s where I draw the line,” Hickok says. “I tell my patients, don’t take the herbs; I don’t know what they do or how they’ll interact with IVF drugs, and they haven’t been tested for safety or purity. With acupuncture, I don’t think there’s a potential for harm, but there could be with the herbs.”

The word spreads

At 40, wedding photographer Janet Klinger had been trying to get pregnant for almost two years. She and her husband knew that IVF wasn’t for them. “I didn’t really want to go through that emotional roller coaster with the possibility of spending 20 grand and not succeeding,” she says.

After hearing about Xie from a pregnant client, she began visiting her twice a month. For three months, she would lie quietly, with needles scattered up her torso, along her “conception channel,” and think “baby thoughts.” She’s now 28 weeks pregnant.

“Whether it’s for scientific reasons or just because I felt so relaxed and cared for, I don’t know, but I totally believe she helped me get pregnant,” Klinger says.

Anecdotes like Klinger’s don’t make for strong medical evidence. Doctors are quick to point out there’s no way of knowing whether she would have gotten pregnant anyway. But such accounts do make the rounds in infertility circles and among women friends.
That’s why, despite not advertising, Xie’s nondescript clinic on Roosevelt Avenue Northeast draws a steady stream of well-heeled women, some IVF patients, some looking for an outright miracle.